Congestive Heart Failure

ByDr. Hanan Said Ali

ObjectivesObjectives

Define congestive heart failure. Enumerate causes of congestive

heart failure.Explain how to assess patients

physically and physiologically. Identify principles of care. Identify nursing care for patients

with congestive heart failure.

Congestive Heart Congestive Heart Failure Failure Definition Acute heart failure is pump failure due to

ischemia or infarction.

CausesMyocardial infarctionDrugs as Beta blockerDysrhythmiasValve dysfunctionVentricular septal defect

Causes Cont.Causes Cont.

Pericardial tamponade

Constrictive pericarditis

Haemorrhage and anaemia

Pulmonary embolusCardiomyopathy

HypertensionThyrotoxic crisisWet beri – beri( vitamin B

deficiency)myocaditis

Assessment ( Signs & Assessment ( Signs & Symptoms.)Symptoms.)Physical assessmentSkinCyanosis, pallor, and sweating. Organ hypoperfusion produces cold.Peripheral oedema.

RespirationThe patient may be tachypnoeic.Blood- stained frothy sputum as a

result of pulmonary oedema.Wheeze

Physical assessment Cont.Physical assessment Cont.

GeneralThe patient may show signs of

generalized weakness and fatigue.

Auscultation Fourth heart sound may be heard.Crepitation may be heard at the

lung bases in left heart failure.

Physiological AssessmentPhysiological AssessmentCVP will be high with right- sided heart

failure.

Blood pressure may be low, normal, or high.

Heart rate tachycardia will usually be evident unless bradycardia is the main cause of failure.

Renal function urine output may be reduced and renal dysfunction evident from blood urea and creatinine levels

Neurological/Psychological Neurological/Psychological assessmentassessmentThe patient may exhibit anxiety and distress,

drowsiness, confusion as a result of poor cardiac output and cerebral hypoperfusion.

InvestigationsInvestigations

12- lead ECG

Chest x- ray

Blood investigation ( urea, electrolytes, haemoglobin, glucose, cardiac enzymes, and brain type natriuretic peptide, this released into bloodstream from the ventricle when it is excessively stretched.

Priorities of carePriorities of careBasic resuscitation measures are

aimed at restoring an adequate circulation as quickly.

Administration of high – flow, high- concentration oxygen.

vasodilators, and diuretics

Priorities of carePriorities of care

Diamorphine 2.5mg IV, reassurance, information and comfort.

Mechanical ventilation.

Principles of carePrinciples of careMonitoringContinuous ECG monitoring.Pulse oximetry and frequent BP

monitoring.Invasive arterial pressure and CVP

monitoring.

RestThe heart can be rested by reducing

the work of breathing through mechanical ventilation.

Principles of carePrinciples of careOptimizing intravascular fluid volume

The circulating volume should be optimized before introducing other drugs.

Supporting the cardiac output.In low- output states the tissues

compensate for the decrease in oxygen delivery by extracting more oxygen .

Principles of carePrinciples of careTherapiesDiureticCause an initial vasodilatation followed,

20- 30 min later, by a diuresis.

NitratesCan be given rapidly either by oral or

sublingual while an infusion is being prepared.

( A drop in blood pressure on a low- dose infusion is suggestive of hypovolaemia)

Principles of carePrinciples of care

Calcium sensitizer agent Improves ventricular contractility

and vasodilates peripherally without having a major impact on cardiac work.

Mechanical ventilation

Nursing care planNursing care planActivity intolerance related to

fatigue secondary to cardiac insufficiency.Expected outcome Nursing intervention

Tolerate activity, have needs met to satisfaction

Have the patient rest in bed (high fowler's position) or chair when tiredProvide emotional and physical rest to reduce oxygen consumption and relieve dyspnea and fatigue.If in bed teach leg exercise to prevent DVTAssess patient daily for dyspnea fatigue, pulse rate to determine level of activity

Nursing care planNursing care planImpaired gas exchange related to

increased preload mechanical failure or immobility.Expected outcome Nursing intervention

Have respiratory rate of 12-18/ min Elevate head of bead to high fowlers position to improve ventilation.Support patients arms on pillows to move arm off and away from chest to facilitate breathing.

Administer oxygen by nasal cannula to improve O2 saturation.

Auscultate for lung and heart sounds& use pulse oximetry.

Nursing care planNursing care planFluid volume excess related to

pump failure.Expected outcome Nursing intervention

Have reduced or absence of oedema Evaluate degree of peripheral oedema and measure abdominal girth dailyAdminister digitalis ( Digoxin)to improve cardiac output and contractility & diuretics to mobilize oedematous fluid.Assess intake and output & and weight patient daily.

Provide salt restricted diet.Observe for hypokalemia.

Nursing care planNursing care planSleep pattern disturbance related

to nocturnal dyspnea.Expected outcome Nursing intervention

Feel rested after sleep Explain etiology of nocturnal dyspnea to reduce fear .

Explore with patient alternative position of comfort such as sleeping with two or more pillow to relieve dyspnea.

Have patient take diuretics early in the day to decrease urination during night.

Nursing care planNursing care planPotential impaired skin integrity

related to oedema or immobilityExpected outcome Nursing intervention

Have no break down of skin at oedematous areas

Identify location and severity of oedema.

Handle oedematous skin gently.

Pad bony prominences to reduce pressure and skin breakdown.

Perform passive ROM exercise to extremities to facilitate venous return of fluid.

Nursing care planNursing care planAnxiety related to dyspnea or

perceived threat to deathExpected outcome Nursing intervention

Express feeling less apprehensive about condition and prognosis.

Asses facial expression and behaviour for feeling of apprehensionAllow patient to ask questions to relieve anxiety.Demonstrate calm behaviour to improve confidence..Use measures to decrease dyspnea.

Nursing care planNursing care planSelf care deficit related to dyspnea

and fatigueExpected outcome Nursing intervention

Achieve ADL with assistance as necessary

Assist patient with all ADL to meet patient needs and to relieve anxiety.Give small, easy digested food.Advise family of patients fluctuating abilities regarding self care activities.

Thank You